Clinical research
The rise of moral emotions in
neuropsychiatry
Leonardo F. Fontenelle, MD; Ricardo de Oliveira-Souza, MD;
Jorge Moll, MD
Introduction
E
arly psychiatrists such as Emil Kraepelin,1 Eugen Bleuler,2 and Kurt Schneider3 have dedicated substantial space in their oeuvres to the discussion of what
has been broadly defined as “emotional symptoms.”
Clinical (or descriptive) psychopathology, heavily rooted in phenomenological philosophy (as exemplified by
Karl Jaspers’ work4), has struggled to provide a conceptual framework to the field for over a century. Broadly
speaking, affectivity has been defined as a group of subjective experiences that share transcendence from its
own boundaries (for influencing personality and behavior), communicability (for being expressed through verbal and nonverbal means), and polarity (for fluctuating
in dual terms, eg, joy and sadness).5 Although concepts
such as feelings or sentiments, emotions, mood, and affect have been frequently used in the neuropsychiatric
literature, progress in understanding their psychopathological implications has been hindered by: (i) the diver-
Clinical psychopathology has largely ignored the developments in the field of social neuroscience. The so-called
moral emotions are a group of affective experiences
thought to promote cooperation, group cohesion, and
reorganization. In this review, we: (i) briefly describe a
provisional taxonomy of a limited set of moral emotions
and their neural underpinnings; and (ii) discuss how
disgust, guilt, anger/indignation, and shame/embarrassment can be conceptualized as key affective experiences in different neuropsychiatric disorders. Based on a
concise review of the literature linking moral emotions,
psychopathology, and neuropsychiatry, we have devised
a simple and preliminary scheme where we conjecture
how specific moral emotions can be implicated in some
categories of DSM-5 diagnoses, potentially helping to
bridge psychopathology and neurobiologically plausible variables, in line with the Research Domain Criteria
initiative. We hope this stimulates new empirical work
exploring how moral emotional changes and their underlying neurobiology can help elucidating the neural
underpinnings of mental disorders.
© 2015, AICH – Servier Research Group
Author affiliations: D’Or Institute for Research and Education, Rio de Janeiro, Brazil (Leonardo F. Fontenelle, Ricardo Oliveira-Souza, Jorge Moll);
Anxiety, Obsessive and Compulsive Spectrum Disorders Program, Institute
of Psychiatry of the Federal University of Rio de Janeiro, Brazil (Leonardo
F. Fontenelle); Brain and Mental Health Laboratory, School of Psychological Sciences & Monash Institute of Cognitive and Clinical Neurosciences,
Monash University, Victoria, Australia (Leonardo F. Fontenelle)
Dialogues Clin Neurosci. 2015;17:411-420.
Keywords: social cognition; motivation; value; emotion; sentiment; affect; psychiatric disorder; descriptive psychopathology
Copyright © 2015 AICH – Servier Research Group. All rights reserved Address for correspondence: Leonardo F. Fontenelle, MD, Anxiety, Obsessive and Compulsive Spectrum Disorders Research Program, Institute of
Psychiatry of the Federal University of Rio de Janeiro, Rua Visconde de
Pirajá, 547, 617, Ipanema, Rio de Janeiro-RJ, Brazil, CEP: 22410-003
(email: lfontenelle@gmail.com)
411
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Clinical research
sity in their constructs as used by clinicians, social psychologists, and neuroscientists; and (ii) the often tacitly
adopted view that the culturally stable “basic emotions”
as communicated by facial expressions,6 or that simple
two-dimensional valence-arousal models7,8 suffice to
capture the complex human emotional make-up. Thus,
despite substantial developments in the understanding
of human emotions, translation of these advances to the
“clinical encounter”9 has been challenging.
As thoughtfully put by Keltner and Kring10: “…given
the prevalent association between emotion disturbance
and psychopathology,11 basic research on emotion and
social interaction provides a conceptual framework for
considering possible causes and consequences of emotional disturbances as well as potential interventions.”
In line with this view, we would like to emphasize that
the growing understanding of the psychology and neurobiology of a class of more elaborate emotions (variously called secondary,12 social,13 or moral14) during the
last two decades may provide important new insights
for psychopathology. Although the importance of this
broad class of emotions and their function in regulating
social relations and self-evaluation had long been recognized by classical Aristotelian philosophy15 and was
elaborated during the Scottish Enlightenment (eg, see
Adam Smith’s theory of moral sentiments16), a systematic scientific approach to moral emotions did not begin
to be used until quite recently.13,14
The emerging field of moral neuroscience
From the psychopathological perspective, early theorists observed that emotions or feelings are often based
on “objects” which human beings appraise or refer
to, eg, people can love, hate, admire, or disdain something or someone, including themselves. The initial attempts to systematize and classify affectivity on clinical
grounds divided evaluative emotions or feelings as negatively or positively valenced, both being potentially referred to (i) self (eg, guilt or pride); or (ii) other people
and objects (eg, disgust or affection).3 Thus, it was evident that emotions often assumed social (by involving
social information or communication) and often moral
(by invoking kinds of social approval or disapproval)
contours. Emotions are said to be moral when they reflect the interests or welfare either of society as a whole
or at least of persons other than the judge or agent.14
Moral emotions are thought to emerge as neural repre-
sentations that rely on the coactivation of brain regions
that code for perception of social cues (temporoparietal
junction and other posterior cortical regions), social
conceptual knowledge (chiefly the anterior temporal
cortex), abstract event sequence knowledge (anterior,
medial, and lateral sectors of the prefrontal cortex), and
basic emotional states (including subcortical structures
such as the basal forebrain and hypothalamus).17,18
The ability of moral emotions to aggregate or alienate human beings is often used to categorize such experiences into prosocial and social aversive ones, respectively. Typically, prosocial emotions lead to cooperation,
helping, reciprocity, reparative actions, and social conformity, and include guilt, embarrassment, compassion,
awe, and gratitude.18,19 Among these, affiliative emotions
are those relying on social attachment (ie, parent-infant,
filial, and pair-bonding, also known as “proximate” or
“basic attachment”) or attachment to nonhuman living
beings (eg, nature), cultural symbols, abstract ideas, and
beliefs (so-called “extended attachment”), which may
explain the remarkable human inclination to cooperate beyond kinship boundaries, even when no reputation gains are at stake.20 Affiliative emotion is a cornerstone for several prosocial emotions that rely on social
bonding (ie, guilt, gratitude, and compassion), but less
so for those that promote social conformity based on
self-interested motivation (eg, embarrassment). In contrast, sentiments linked to interpersonal aversion—the
other-critical sentiments (such as disgust, contempt, and
anger/indignation)—are experienced when others violate norms or one’s rights or expectations, and endorse
aggression, punishment, group dissolution, and social
reorganization.14,17
The functional role of moral emotions in regulating
social behavior is intrinsically dependent on culture.
Culture is the sculptor of moral beliefs and norms, shaping the ways by which elicitors and specifiers lead interpersonal feelings according to contextual elements and
social niches. For example, feeling shame when violating some “etiquette” codes in the Victorian era would
not apply today in most situations. Similarly, physical violence as a mean to clear one’s honor following a verbal
insult (to avoid shame) was commonplace and acceptable not long ago, but is largely rejected today in most
Western cultures. Nonetheless, for psychopathology it
is important to emphasize that some emotional experiences can be abnormally heightened or blunted after
accounting for what is considered to be “normal” in a
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Moral emotions in neuropsychiatry - Fontenelle et al
given sociocultural niche. Likewise, feelings of blame
towards oneself can be heightened in major depression21 and absent in psychopathy.22,23 With this in mind,
we believe it is possible to envisage a model of moral
emotions that may have heuristic value and allow us
to make better predictions regarding psychopathology,
behavior dysfunctions, and their neural underpinnings
in neuropsychiatric disorders.
Moll and colleagues19 proposed a framework for
moral emotions, with six main components defined on
the basis of their psychological and neurobiological
plausibility. In this schematic model, domains of attachment, aggressiveness, and social rank/dominance/selfesteem correspond to basic cognitive and emotional
mechanisms that are widely represented across species.
In contrast, outcome assessment, agency/intentionality, and norm violation are cognitive capacities readily
identifiable in humans that rely more on differentiated
integrative systems. It is notably difficult to extrapolate
a taxonomy of moral emotions to clinical disorders,
however, and any attempt to translate concepts from
experimental neuroscience to the “clinical encounter”
embedded in the practice of neuropsychiatry should be
considered preliminary and taken with a grain of salt.
Therefore, much of what will be discussed in this review
will require corroboration, correction, and extension
from future experimental and theoretical work. In the
following sections, we will: (i) briefly describe a provisional taxonomy of a limited set of moral emotions and
their putative neural underpinnings19; and (ii) discuss
how disgust, guilt, anger/indignation, and shame/embarrassment can be conceptualized as key emotional
ingredients in the experiences of patients suffering different neuropsychiatric disorders. A thorough coverage
of the emotional space, its neural underpinnings, and
psychopathological associations is beyond the scope of
the present paper.
and experience in humans is often associated with its
moral counterparts, including contempt or moral disgust.24 As Haidt14 noted: “In evolution, the function of
disgust shifted: a mechanism for avoiding harm to the
body became a mechanism for avoiding harm to the
soul.” Two dimensions of disgust have been established,
one related to the tendency to react with the emotion
of disgust (disgust propensity) and the other related to
how unpleasant the experience of disgust is to the individual (disgust sensitivity), each thought to be involved
in specific forms of psychopathology.25
On an interpersonal level, disgust and contempt
sometimes mark distinctions of rank and prestige, especially in hierarchical societies.19 Moral disgust, arguably
a more extreme form of contempt that can be a motivational factor for severe antisocial behaviors such as
hate crimes and genocides, is evoked by characterological blame to others26 and devaluation of their social status (ie, attribution of lower social value to persons or
groups). Contempt and disgust can also be elicited by
minor social norm violations in which another person is
the agent. Severe social violations will generally trigger
indignation instead, and are more associated with behavioral blame. The neural correlates of disgust include
the anterior insula, the anterior cingulate, and inferior
temporal cortices, the basal ganglia, the amygdala, and
the lateral orbitofrontal cortex,19 with preliminary evidence suggesting that more dorsomedial divisions of
the prefrontal cortex are recruited by moral disgust.27
Also, there is evidence suggesting that, despite the
fact that moral disgust and core disgust share common
neural representations, the latter engages the left inferior frontal gyrus more reliably, whereas moral disgust
(triggered by taboo stimuli) elicits stronger medial prefrontal cortex and temporoparietal junction cortical responses.28
Psychopathological associations
Disgust, contempt, and moral disgust
Psychology and neuroscience
Disgust has been described as “the revulsion at the
prospect of oral incorporation of an offensive contaminating object” in a way that “if they even briefly contact
an acceptable food, they tend to render that food unacceptable.” Although disgust is one of the classical “basic
emotions” (in this case, “core” disgust), its expression
Most work done on the descriptive psychopathology of
disgust has been based on its more traditional rather
than interpersonal meaning (ie, the so-called “core disgust”). Besides its well-known role in contaminationrelated obsessive-compulsive disorder (OCD), bloodinjection-injury phobia, and small animal phobias,29
abnormal disgust processing is likely to be involved in
several other mental disorders, including eating and
sexual disorders,29 and other obsessive-compulsive and
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Clinical research
related disorders (OCRDs), such as body dysmorphic
disorder (BDD), olfactory reference syndrome (ORS),
and hoarding disorder (HD). For instance, in eating
disorders, some patients may express disgust for highcalorie foods and overweight body shapes.30 In contrast,
women suffering from sexual aversion disorder display
a number of sex-related fears, aversion to looking or
touching their own or others’ genitalia, and disgust regarding body fluids.31,32
Disgust appears to be an important ingredient of the
emotional experience of patients suffering from several
“cognitively based” OCRDs. Patients with BDD are
preoccupied by and often disgusted by their own appearance,33 while ORS patients believe they emanate
obnoxious odors, including “sewage,” “rotten animals”
and other fetid smells, which the individual believes
generate disgust reactions in other people.34 Some
hoarding patients (particularly those who exhibit a
severe domestic squalor) may also seem to be insensitive or indifferent to the consequences of hoarding
behaviors, including vermin, insects, and extreme filth.35
Lastly, OCD patients may also display a form of selfdisgust for having immoral sexual/religious thoughts.36
Whether increased “interpersonal disgust” or contempt
toward others may be found in manic episodes (eg,
bipolar disorder), psychotic disorders (eg, delusional
disorders, grandiose type), or personality disorders associated with increased self-esteem (eg, narcissistic or
other cluster B personality disorders) is an interesting
possibility that remains to be investigated.
Guilt
not required for guilt elicitation, the acknowledgement
that a social norm was violated may magnify feelings of
guilt,19 suggesting that deontological and altruistic guilt
may coexist and have additive effects.
Neuroimaging data showed that the experience of
guilt is mediated by the anterior prefrontal (frontopolar) cortex, the dorsomedial prefrontal and the lateral
orbitofrontal cortex, the anterior temporal cortex, the
insula, the amygdala, the anterior cingulate cortex, and
the superior temporal sulcus region.19,39,40 In addition, in
one study measuring concerns about payoffs to oneself
and to others using dictator, ultimatum, and trust games,
six patients with ventromedial prefrontal cortex lesions
donated significantly less, and were less trustworthy.
Mathematical models showed that these patients were
abnormally insensitive to guilt, but not to envy.41
The subgenual cortex has been implicated in major
depressive disorder (MDD), as well as in individual
differences in empathic concern during guilt provocation in normal volunteers.42 In line with these findings,
this brain region showed heightened hemodynamic responses in patients with remitted MDD when making
altruistic donations,43 which have been previously demonstrated to engage the subgenual cortex in healthy
volunteers.44 In addition, evidence obtained in patients
with the behavioral variant of frontotemporal dementia
suggests that the frontopolar cortex and the septal region are required for guilt.45 Notably, in the later study,
impairments of other-critical feelings (anger and disgust) were associated with dorsomedial prefrontal and
amygdala dysfunction.45
Psychopathological associations
Psychology and neuroscience
In contrast to adaptive guilt, “pathological” guilt is motivated by the desire to ensure that the “wrong” is made
“right” at the expense of maintaining social norms and
mutuality of social relationships.37 Typically, guilt develops when one foresees a bad outcome for another person, recognizes him or herself as the agent of such an
outcome, and feels emotionally attached to the damaged
person or abstract value (eg, justice, honesty).19 Guilt
can derive from the transgression of a moral rule (also
termed deontological guilt, eg, “do not play God”) or of
a personal altruistic goal (also know as altruistic guilt,
eg, feeling guilty for having hurt someone’s feelings).38
Although violations of social norms in themselves are
Self-blaming biases, including guilt, have been implicated in MDD (particularly in melancholic forms),21,23,46
post-traumatic stress disorder (PTSD),47 and OCRDs.38
Patients with remitted MDD exhibit an increased selfcontempt bias, ie, less contempt/disgust and indignation
towards others despite having unimpaired self-blame
(guilt and self-contempt).48 Guilt is thought to play a
key role in PTSD, thought it is not clear whether it results from exposure to trauma, depression, shame, or
the full-blown clinical syndrome itself.47 There are many
OCRDs that have been associated with abnormalities
in guilt processing. Studies suggest that OCD is associated with increased sensitivity to deontological, but not
altruistic, guilt.38 Also, overscrupulous OCD patients49
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and HD patients who find themselves obliged to discard objects to which they are emotionally attached50
may be more prone to manifest increased guilt.
In contrast to other OCRD patients, who show
heightened experiences of guilt before the execution
of their compulsions, trichotillomania, and excoriation
(skin picking) disorder, patients tend to display guilt
only after they perform their abnormal behaviors and
realize the extension of the damage and the social consequences.51 This latter feature is shared by many substance and behavioral addictions (including gambling
disorder), disruptive, impulse control, and conduct disorders (ie, intermittent explosive disorder, pyromania,
and kleptomania), and paraphilias.52 Psychopathy is a
disorder characterized by pronounced emotional deficits, marked by reduction in guilt and remorse, which
contribute to their callous and antisocial behaviors.
Structural and functional abnormalities have been reported in brain networks implicated in guilt and other
prosocial emotions in psychopathy.53,54 For instance, in
contrast to individuals characterized by reactive aggressiveness (ie, intermittent explosive disorder), subjects
showing psychopathic traits exhibit decreased amygdala and orbitofrontal cortex responses to emotionally
provocative stimuli or during emotional learning paradigms (for a review, see Blair55).
Anger and indignation
Psychology and neuroscience
Anger has been defined as a negative affect that arises
from the blockage of movement toward a desired goal
that “ought to be.”56 Although anger as a basic emotion does not necessarily involve a moral context for
its expression (you may get angry at a malfunctioning
device or because of a traffic jam), indignation requires
the recognition of injustice or other moral violations.
It remains unclear, however, whether their emotional
experience can be clearly distinguished. Furthermore,
anger/indignation and moral disgust share several
phenomenological commonalities, but are typically
elicited in different contexts: while moral disgust is
predominantly felt in response to “bodily moral violations,” such as a lack of respect for sexual or eating
taboos,57 anger/indignation is mostly a reaction to violations of sociomoral norms about fairness, harm, or
rights in which another person is the agent, especially
if the agent acted intentionally.19 Anger/indignation
also relies on engagement of aggressiveness, following
an observation of bad outcomes to the self or to a third
party.19 Typically, anger/indignation evokes activation
of the orbitofrontal cortex (especially its lateral division), the dorsomedial prefrontal and frontopolar cortex, the anterior insula, the amygdala, and the anterior
cingulate cortex.17,18,28,40 Damage to the amygdala and
to the dorsomedial prefrontal cortex in patients with
frontotemporal dementia impairs feelings of anger/indignation and disgust.45
Psychopathological associations
Anger (and indignation, though seldom mentioned explicitly) is a relatively pervasive emotional experience
in everyday life, and prevalent in mental disorders in
general. Although it is frequently found in psychosis,
mania, and even depression, DSM-5 also lists a number
of conditions that exhibit anger or indignation as core
diagnostic features, including intermittent explosive
disorder, disruptive mood dysregulation disorder, antisocial and borderline personality disorders, and conduct and related disorders, among others.52 Regardless
of its etiology, anger can also severely modify the expression of other mental disorders, ie, by increasing the
burden on the family, friends, and society as a whole.58
For instance, neurodevelopmental conditions, such as
autism spectrum disorders59 and Tourette syndrome,60
are also frequently associated with rage attacks. In
OCD, individuals presenting symmetry/ordering symptoms seem particularly prone to exhibit increased anger
and aggressiveness.61 As reported above, there is also
some evidence showing decreased negative feelings toward the others (especially anger/indignation) among
patients with remitted MDD.48
Shame
Psychology and neuroscience
Shame reflects a concern with a threatened self,
which motivates behaviors to restore a positive view
of himself or herself.12,62,63 It most probably evolved
as an attempt to mitigate the likelihood or costs of
reputation-damaging information spreading to others
(loss of face).64 In fact, compared with other prosocial
emotions, shame uniquely predicts a desire for self-
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Clinical research
Disgust
Guilt
Anger/indignation
Shame
Neurodevelopmental disorders
Autism spectrum disorders with self-injurious behaviors
↑
Tourette syndrome
↑
↑
↑
↓
Schizophrenia and other psychotic disorders
Delusional disorder, grandiose, jealous and persecutory types
↑
Delusional disorder, somatic type
↑
Bipolar and related disorders
Manic/hypomanic episode
↓
↑
↑
↓
↓
Depressive disorders
Major depressive episode with melancholic features
↑
Major depressive episode, with atypical features
Anxiety disorders
↑
Specific phobia, animal type
↑
Social anxiety disorder
Obsessive-compulsive and related disorders
Obsessive-compulsive disorder
↑
Concerns about germs and contamination
↑
Concerns about responsibility
↑
Symmetry, completeness, and “just right”
↑
Unacceptable thoughts
Body dysmorphic disorder and olfactory reference syndrome
↑
Hoarding disorder
↓
↑
↑
↑
↑
↑
↑
↑
↑
↑
↑
↑
↑
↑
Trichotillomania and excoriation disorder
Trauma- and stressor-related disorders
Post-traumatic stress disorder
Feeding and eating disorders
Eating disorders
Sexual dysfunctions
Genito-pelvic pain disorder
Disruptive, impulse control, and conduct disorders
Oppositional defiant disorder
↑
Intermittent explosive disorder
↑
↑
↑
↓
↓
Conduct disorder
↓↑
Substance-related and addictive disorders
↓↑
Personality disorders
↓
↑
↓
Borderline personality disorder
↑
↓
↑
↑
Narcissistic personality disorder
↑
↓
↑
↓
Antisocial personality disorder
Table I. Examples of DSM-5 entities and how their predominant moral emotions can help illuminate the pathophysiology of mental disorders.
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change.65 It may focus on the body, intimacy and sexuality (bodily shame); on the person’s moral standards,
competence, and social exclusion (cognitive shame);
or on the person as a whole (existential shame).66 Although shame has been considered a central emotion
to the psychopathology of social phobia/social anxiety
disorder (SAD), it is probably a much wider concept
then merely social anxiety. Similarly, the experience of
shame in SAD may be magnified by the expression of
particular attitudes by specific groups of patients. For
instance, submissive behaviors mediated the relationship between social anxiety and shame in men, but not
women, with SAD.67
Shame follows “an action attributed to self-agency
that is associated with a violation of a social norm, leading to a bad outcome to oneself (eg, damage to one’s
self-image), and reduced self-esteem and social dominance as judged by oneself and others, which is often
reliant on the other’s awareness or one’s action.” 19 A
similar emotion to shame, embarrassment, follows the
violation of less severe social norms or conventions,
leading to a non-pervasive or non-characterological
reduction of one’s self-image, which is dependent on
other’s awareness (being observed).19 Perhaps a milder
variation of shame, embarrassment is not thought to be
associated with a significant reduction of self-esteem
or to a sustained decrease in self-attributed social status.19 In one fMRI study, shame/guilt conditions, as well
as pride, activated an emotional circuit including the
amygdala, the insula, and the ventral striatum, and the
bilateral dorsomedial prefrontal cortex.68 In another
study that attempted to disentangle the neural correlates of shame from guilt, both were associated with
increased activations in the temporal lobes. However,
shame activated most specifically the medial and inferior frontal gyrus, while guilt lead to greater activity in
the amygdala and the insula.69
Psychopathological associations
While it is difficult to establish the psychopathological significant of embarrassment, an excessive level of
shame may be associated with a wide range of psychopathological symptoms. However, a lack of shame may
also lead to distress, for instance as it may facilitate violation of social norms and thus may promote interpersonal problems. In one study, SAD patients displayed
greater bodily and cognitive shame than community
and psychiatric control groups.66 Fortunately, however,
shame in SAD seems to be amenable to treatment.70
Increased shame is also often reported in eating disorders,71 PTSD,72 and OCD patients, particularly those
with sexual, blasphemous, or hoarding symptoms.73
Finally, the experience of shame may also result from
excessive grooming behaviors and their esthetical consequences as in trichotillomania and excoriation disorder, inability to discard items and the resulting clutter in
HD, imaginary defects in the appearance in BDD and
beliefs about emanating repulsive odors in ORS.74 In
the same study reported above,66 while borderline personality disorder patients reported the highest level of
“existential” shame (ie, an enduring feeling of shame
comprising the person as a whole) as compared with
community and other psychiatric control groups, attention deficit/hyperactivity disorder patients exhibited
the lowest severity of “bodily” shame.
Conclusions
It is important for neuropsychiatry to crosstalk with
social neurosciences, as research on the neural basis
of moral emotions can help inform the pathophysiology of mental disorders and, ultimately, develop innovative diagnostic and treatment targets. Surprisingly, a
resurgence of the descriptive psychopathology of emotions, a discipline that has been dormant for more than
50 years, will open up a rich avenue for investigation
that has been unduly obliterated by the rise of animal
models of emotional processing since the first quarter
of the 20th century. Such models, by nature and necessity, largely ignored the uniqueness of human existential and moral feelings.75 Based on a concise review of
the literature linking moral emotions, psychopathology,
and neuropsychiatry, we have devised a simple and provisional scheme where we conjecture how moral emotions can be disturbed in some categories of DSM-5 diagnoses, potentially helping to bridge psychopathology
and neurobiologically plausible variables, in line with
the RDoC initiative.76 We hope this stimulates new empirical work exploring how moral emotional changes
and their underlying neurobiology can help elucidate
the neural underpinnings of mental disorders (Table 1).
The identification of neurocircuitries mediating abnormal emotional processing in neuropsychiatric disorders may have implications that transcend the boundaries of neuroanatomy, particularly in terms of cognition,
417
Clinical research
neuroendocrinology, and molecular genetics.77 In contrast to more basic psychological constructs such as basic emotions, moral emotions map onto a phenomenological level that is likely to be closer to their neural
network, symptomatic and psychological counterparts,
thereby representing a very interesting venue for fundamental research and clinical inquiry. This endeavor
can also help sharpen ideal targets for different forms
of neurostimulation and other neurosurgical procedures, or to better select treatment candidates based on
a more personalized approach. While these therapeutic approaches seem relatively aggressive for some of
the conditions described in DSM-5, new neuromodulation approaches based on neurotechnological advances,
combined with a better knowledge of how distributed
brain networks encode specific complex cognitive-emotional states (and traits), such as those associated with
moral emotions and different motivations, may help devise effective noninvasive treatments for neuropsychiatric conditions. o
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Dialogues in Clinical Neuroscience - Vol 17 . No. 4 . 2015
Moral emotions in neuropsychiatry - Fontenelle et al
El surgimiento de las emociones morales en
neuropsiquiatría
L’essor des émotions morales en neuropsychiatrie
La psicopatología clínica ha ignorado ampliamente los
desarrollos en el campo de la neurociencia social. Las así
llamadas emociones morales son un grupo de experiencias afectivas que se piensa promueven la cooperación,
la cohesión grupal y la reorganización. En esta revisión
1) se describe brevemente una taxonomía provisoria de
un conjunto limitado de emociones morales y sus sustratos neurales y 2) se discute cómo el asco, la culpa, la
ira/enojo y la vergüenza/bochorno pueden ser conceptualizadas como experiencias afectivas clave en diversos
trastornos neuropsiquiátricos. En base a una breve revisión de la literatura que vincula las emociones morales,
la psicopatología y la neuropsiquiatría se ha ideado un
esquema simple y preliminar donde se supone que las
emociones morales específicas se pueden implicar en
algunas categorías diagnósticas del DSM-5, ayudando
potencialmente a unir las posibles variables psicopatológicas y neurobiológicas, en línea con la iniciativa del
Research Domain Criteria. Se espera que esto estimule a
nuevos trabajos empíricos que exploren cómo los cambios emocionales morales y su neurobiología subyacente pueden ayudar a dilucidar las bases neurales de los
trastornos mentales.
La psychopathologie clinique a largement ignoré les
développements dans le domaine des neurosciences sociales. Les émotions dites morales sont un groupe d’expériences affectives destinées à promouvoir la coopération,
la cohésion de groupe et la réorganisation. Dans cet article, 1) nous décrivons brièvement une taxinomie provisoire d’un ensemble limité d’émotions morales et de leurs
fondements neuronaux ; et 2) nous analysons comment
il est possible de conceptualiser le dégoût, la culpabilité,
la colère/l’indignation et la honte/la gêne comme expériences affectives-clés dans différents troubles neuropsychiatriques. Sur la base d’une revue concise de la littérature associant les émotions morales, la psychopathologie
et la neuropsychiatrie, nous avons conçu un projet préalable simple dans lequel nous supposons l’implication des
émotions morales spécifiques dans certaines catégories
diagnostiques du DSM-5, aidant éventuellement à établir des liens avec des variables psychopathologiques et
neurobiologiques crédibles, conformes avec l’initiative
des Research Domain Criteria (Critères de domaines de
recherche). Nous espérons ainsi stimuler un nouveau travail empirique en étudiant comment les changements
moraux émotionnels et leur neurobiologie sous-jacente
peuvent permettre de comprendre les fondements neuronaux des troubles mentaux.
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